S10: Chronic sleep deprivation as a unifying markers of sleep disorders in children with attention deficit hyperactivity disorder (ADHD)

S10: Chronic sleep deprivation as a unifying markers of sleep disorders in children with attention deficit hyperactivity disorder (ADHD)
Saturday, April 28 | 4:00pm-5:30pm | Room 341

Chair: Michel Lecendreux (France)

Alexandre Datta (Switzerland)
Oliviero Bruni (Italy)
Silvia Miano (Switzerland)

Summary of symposium:
Considering the impact of ADHD symptoms on patients’ lives, many studies focused on identifying endophenotypes for early detection and prevention of ADHD. One of the most extensively researched area with this aim is the recognition of sleep problems associated with ADHD, with increasing numbers of papers published over the last decades considering that chronic sleep deprivation induce diurnal symptoms of ADHD. According to the literature five sleep phenotypes have been proposed to be associated with either an increased or decreased level of arousal. An hypoarousal state, which may be considered a “narcolepsy-like” form of ADHD; delayed sleep onset insomnia; obstructive sleep apnea syndrome (OSA); restless legs syndrome and/or periodic limb movements; and sleep epilepsy and/or EEG interictal epileptiform discharges during sleep. Sleep onset insomnia is the most common sleep disorder reported in children with ADHD, which seems to be the expression of a delayed sleep-wake cycle, and the school schedules induce in these children a chronic sleep deprivation. Many papers have evidenced that children with ADHD may have a mild form of OSA. The neurocognitive phenotype of paediatric OSA resemble the dysfunction of the prefrontal cortex of ADHD, and it has been related to the brain damage induced by intermittent hypoxia and sleep fragmentation; with a significant improving of ADHD symptoms after treatment of OSA. Similarly to children with OSA, a comorbidity with RLS/PLMs has been reported in about 12 % of children with ADHD, with a positive correlation between RLS/PLMs and hyperactivity/opposition scores. Finally, literature data supports in some cases of ADHD the causal relationship with the occurrence of interictal epileptiform discharges (IEDs) during sleep, mostly represented by those also observed in benign centrotemporal spike epilepsy (BCTE). Interestingly, a reduced arousability similar to those found in ADHD and in narcolepsy, has been reported in children with BCTE. Finally, children with ADHD have been reported to show a neuro-maturational delay in cortical topographical SWA distribution in comparison to healthy children,with a local increase of SWA over central regions, which may represent a marker of chronic sleep deprivations, despite the presence or not of specific sleep disorders. Thus, the aim of this symposium is to update the knowledge of specific sleep disorders in children with ADHD, in order to best sequence different treatment strategies according to the specific sleep phenotype of ADHD. Moreover the aim is to identify a marker of chronic sleep deprivation in terms of topographic and source analysis of SWS in children with ADHD.

Learning Objectives:
Upon Completion of this CME activity, participants should be able to:

1 Determine similarities and differences in attention deficit and executive dysfunction in children with benign epilepsy compared to ADHD
2 Determine similarities and differences of periodic limbic movements activity and sleep hyperkinesia in children with ADHD compared to paediatric restless legs syndrome
3 Determine the potential repercussions of sleep deprivation in children with ADHD and sleep delayed phase syndrome, comparing the effect of stimulants to melatonin and light therapy
4 Define sleep phenotype of ADHD, establishing a diagnostic and therapeutic algorithm, and analyse the topographic mapping of sow wave activity in children with ADHD, as a marker of chronic sleep deprivation

Target Audience:
Pediatricians, neuro-pediatricians, pediatric psychiatrists and psychologists